Provider Demographics
NPI:1154811701
Name:TILDEN PHARMACY
Entity type:Organization
Organization Name:TILDEN PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENR/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-887-5426
Mailing Address - Street 1:103 E 2ND ST
Mailing Address - Street 2:POB 190
Mailing Address - City:TILDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68781-4793
Mailing Address - Country:US
Mailing Address - Phone:402-368-5385
Mailing Address - Fax:402-368-5386
Practice Address - Street 1:103 E 2ND ST
Practice Address - Street 2:
Practice Address - City:TILDEN
Practice Address - State:NE
Practice Address - Zip Code:68781-4793
Practice Address - Country:US
Practice Address - Phone:402-368-5385
Practice Address - Fax:402-368-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336L0003X
NE7173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177575OtherPK